scholarly journals Diagnostic workup for endometrioid borderline ovarian tumors (eBOT) requires histopathological evaluation of the uterus

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Juliane Reichenbach ◽  
Elisa Schmoeckel ◽  
Sven Mahner ◽  
Fabian Trillsch
Keyword(s):  
Treatment Guidelines ◽  
Young Patients ◽  
Diagnostic Workup ◽  
Histological Evaluation ◽  
Borderline Ovarian Tumor ◽  
Primary Tumors ◽  
Histopathological Evaluation ◽  
Uterine Curettage ◽  
Unexpected Findings ◽  
Current Guidelines

Abstract Background For young borderline ovarian tumor (BOT) patients, preservation of the uterus was incorporated as an accepted option into treatment guidelines. For the endometrioid subtype (eBOT) however, adequate histological evaluation is challenging and might be associated with synchronous endometrial disorders or misinterpreted as spread from uterine primaries. Case presentation We report the cases of two young patients with eBOT who underwent treatment according to current guidelines. In both cases, unexpected findings of invasive uterine carcinomas were established in final histopathological evaluation. Conclusions This constellation highlights the challenging diagnostic workup of BOT and underlines that uterine curettage is indispensable for eBOT to exclude uterine primary tumors when fertility preservation is planned. Accordingly, we suggest to include this procedure into recommendations for diagnostic workup and to state the potential risk in treatment guidelines.

scholarly journals Diagnostic Workup for Endometrioid Borderline Ovarian Tumors (eBOT) Requires Histopathological Evaluation of the Uterus

2021 ◽  
Author(s):  
Juliane Reichenbach ◽  
Elisa Schmoeckel ◽  
Sven Mahner ◽  
Fabian Trillsch
Keyword(s):  
Ovarian Tumor ◽  
Treatment Guidelines ◽  
Young Patients ◽  
Diagnostic Workup ◽  
Histological Evaluation ◽  
Borderline Ovarian Tumor ◽  
Primary Tumors ◽  
Uterine Curettage ◽  
Unexpected Findings ◽  
Current Guidelines

Abstract BackgroundFor young borderline ovarian tumor (BOT) patients, preservation of the uterus was incorporated as an accepted option into treatment guidelines. For the endometrioid subtype (eBOT) however, adequate histological evaluation is challenging and might be associated with synchronous endometrial disorders or misinterpreted as spread from uterine primaries. Case presentationWe report the cases of two young patients with eBOT who underwent treatment according to current guidelines. In both cases, unexpected findings of invasive uterine carcinomas were established in final histopathological evaluation.ConclusionsThis constellation highlights the challenging diagnostic workup of BOT and underlines that uterine curettage is indispensable for eBOT to exclude uterine primary tumors when fertility preservation is planned. Accordingly, this procedure needs to be included in recommendations for diagnostic workup and the potential risk should be clearly stated in treatment guidelines.

Management and Prognosis of Clear Cell Borderline Ovarian Tumor

2012 ◽  
Vol 22 (6) ◽  
pp. 993-999 ◽  
Author(s):  
Catherine Uzan ◽  
Marion Dufeu-Lefebvre ◽  
Raffaele Fauvet ◽  
Sebastien Gouy ◽  
Pierre Duvillard ◽  
...  
Keyword(s):  
Ovarian Tumor ◽  
Clear Cell ◽  
Young Patients ◽  
Good Prognosis ◽  
Stage I ◽  
Borderline Ovarian Tumor ◽  
Median Period ◽  
Uterine Curettage ◽  
Intraepithelial Carcinoma ◽  
Lost To Follow Up

BackgroundThe clear cell borderline ovarian tumor (CCBOT) of the ovary is a rare tumor accounting for less than 1% of BOT. Fewer than 25 cases have been reported in the literature (including details on clinical management and outcomes). The aim of this study was to determine the prognosis of a series of CCBOTs collected in 2 reference centers.Patients and MethodsThis was a retrospective review of patients with CCBOT treated or referred to our institutions. A centralized histological review by a reference pathologist and data on the clinical characteristics, management, and outcomes of patients were required for inclusion.ResultsTwelve patients were identified between 2000 and 2010. The median age of patients was 68 years (range, 36–83 years). Two had been treated conservatively and 9 radically (data unknown in 1). The tumor was unilateral in 11 cases. All patients had stage I disease. All cases were CCBOT with an adenofibromatous pattern. Stromal microinvasion or intraepithelial carcinoma was histologically associated in 2 and 3 cases, respectively. Four of the 12 patients had synchronous endometrial disorders (but no endometrioid carcinoma). No cases were histologically associated with endometriosis. Four patients were lost to follow-up. Among 8 other patients, after a median period of 28 months (range, 2–129 months), no recurrence had occurred (1 patient had died of another disease).ConclusionClear cell borderline ovarian tumor carries a good prognosis. All tumors are stage I; therefore, surgical staging is not necessary in most of the cases. Conservative treatment could be proposed to young patients, but uterine curettage would then be required in cases of uterine preservation.

scholarly journals Incidental Gallbladder Cancer: Routine versus Selective Histological Examination After Cholecystectomy

2021 ◽  
Vol 07 (01) ◽  
pp. e22-e25
Author(s):  
Andrew Alabi ◽  
A D. Arvind ◽  
Nikhil Pawa ◽  
Shakir Karim ◽  
Jason Smith
Keyword(s):  
Gallbladder Cancer ◽  
Gallstone Disease ◽  
Papillary Adenocarcinoma ◽  
University Teaching ◽  
Histological Evaluation ◽  
Adenocarcinoma In Situ ◽  
Invasive Adenocarcinoma ◽  
Potential Cost ◽  
Histopathological Evaluation ◽  
Incidental Gallbladder Cancer

Abstract Background Incidental gallbladder cancer is relatively rare, with an incidence ranging between 0.19 and 5.5% of all the cholecystectomies for benign disease, and carries a poor prognosis. Currently, in the literature, there appears to be some controversy about whether all gallbladder specimens should be sent for routine histopathology. The aim of this study was to investigate the need for either routine or selective histopathological evaluation of all gallbladder specimens following cholecystectomy in our institution. Methods The records of all patients who underwent a cholecystectomy (laparoscopic and open) for gallstone disease over a 5-year period (between January 2011 and January 2016) were reviewed retrospectively in a single university teaching hospital. Patients with radiological evidence of gallbladder cancer preoperatively were excluded. The notes of patients with incidental gallbladder cancer were reviewed and data were collected for clinical presentation and preoperative investigations including blood tests and radiological imaging. Results A total of 1,473 specimens were sent for histopathological evaluation, with two patients being diagnosed with an incidental gallbladder cancer (papillary adenocarcinoma in situ and moderately differentiated invasive adenocarcinoma [stage IIIa]). The incidence rate was 0.14%. All patients with incidental gallbladder cancer had macroscopically abnormal specimens. Conclusion Both patients in our study who were diagnosed with incidental gallbladder cancer had macroscopic abnormalities. A selective rather than routine approach to histological evaluation of gallbladder specimens especially in those with macroscopic abnormalities should be employed. This will reduce the burden on the pathology department with potential cost savings.

scholarly journals There is no role for uterine curettage in the contemporary diagnostic workup of women with a pregnancy of unknown location

2006 ◽  
Vol 21 (10) ◽  
pp. 2706-2710 ◽  
Author(s):  
G. Condous ◽  
E. Kirk ◽  
C. Lu ◽  
B. Van Calster ◽  
S. Van Huffel ◽  
...  
Keyword(s):  
Diagnostic Workup ◽  
Uterine Curettage ◽  
Pregnancy Of Unknown Location

scholarly journals Therapeutic Management of Rare Primary Ovarian Neoplasms: Carcinosarcoma, Leiomyosarcoma, Melanoma and Carcinoid

2021 ◽  
Vol 18 (15) ◽  
pp. 7819
Author(s):  
Mateusz Kozłowski ◽  
Katarzyna Nowak ◽  
Agnieszka Kordek ◽  
Aneta Cymbaluk-Płoska
Keyword(s):  
Clinical Case ◽  
Ovarian Neoplasms ◽  
Treatment Guidelines ◽  
Case Reports ◽  
Review Of The Literature ◽  
Pharmacological Treatments ◽  
International Database ◽  
Primary Tumors ◽  
Fertility Sparing ◽  
Oncological Centers

Carcinosarcoma, leiomyosarcoma, melanoma and carcinoid as primary tumors in the ovary are extremely rare. In this paper, the authors reviewed the literature from 2010 to 2021, based on specific criteria, to analyze the treatment of these rare ovarian neoplasms. We also aimed to verify whether modern therapies have been found in recent years. For this article, 80 papers were finally selected. The vast majority of the articles were clinical case reports. Despite single mentions of new potential pharmacological treatments, surgery (radical or fertility-sparing) is definitely the mainstay of treatment. There are currently no treatment guidelines for these tumors. A review of the literature has revealed the use of various adjuvant treatments. We, therefore, believe that a more detailed understanding of the biology of these tumors is necessary in order to find new target points for treatment. We would like to emphasize the importance of creating an international database of rare ovarian tumors which would make it possible to gather data from various oncological centers and enable further research into these neoplasms.

scholarly journals Who Should Rather Undergo Transesophageal Echocardiography to Determine Stroke Etiology: Young or Elderly Stroke Patients?

2020 ◽  
Vol 11 ◽  
Author(s):  
Christoph Strecker ◽  
Felix Günther ◽  
Andreas Harloff
Keyword(s):  
Secondary Prevention ◽  
Transesophageal Echocardiography ◽  
Treatment Guidelines ◽  
Age Groups ◽  
Cryptogenic Stroke ◽  
Young Patients ◽  
Old Patients ◽  
Stroke Etiology ◽  
Risk Sources ◽  
The Impact

Introduction: The indication of transesophageal echocardiography (TEE) in acute stroke is unclear. Thus, we systematically studied the impact of TEE on determining stroke etiology and secondary prevention in patients of different age-groups with cryptogenic stroke.Methods: Four hundred and eighty five consecutive patients with acute retinal or cerebral ischemia were prospectively included and underwent routine stroke workup including TEE. Stroke etiology was identified according to the TOAST classification and patients were divided in those with determined and cryptogenic stroke etiology without TEE results. Then, the frequency of high- and potential-risk sources in TEE was evaluated in <55, 55–74, and ≥75 year-old patients with cryptogenic stroke etiology.Results: Without TEE, stroke etiology was cryptogenic in 329(67.8%) patients and TEE determined possible etiology in 158(48.4%) of them. In patients aged <55, 55–74, ≥75, TEE detected aortic arch plaques ≥4 mm thickness in 2(1.2%), 37(23.0%), and 33(40.2%) and plaques with superimposed thrombi in 0(0.0%), 5(3.1%), and 7(8.5%); left atrial appendage peak emptying flow velocity ≤30cm/s in 0(0.0%), 1(0.6%), and 2(2.4%), spontaneous echo contrast in 0(0.0%), 1(0.6%), and 6(7.3%), endocarditis in 0(0.0%), 0(0.0%), and 1(1.2%) and patent foramen ovale (PFO) plus atrial septum aneurysm (ASA) in 18(20.9%), 32(19.9%), and 14(17.1%), respectively. TEE changed secondary prevention in 16.4% of these patients following guidelines of 2010/11 and still 9.4% when applying the guidelines of 2020.Conclusions: TEE was highly valuable for determining stroke etiology and influenced individual secondary prevention based on available treatment guidelines and expert opinion in most cases. In young patients the impact of TEE was limited to the detection of septal anomalies. By contrast, in older patients TEE detected high numbers of complex aortic atheroma and potential indicators of paroxysmal atrial fibrillation.

Molecular characterization of early vs. late onset gastroesophageal cancers.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 46-46
Author(s):  
Sadaf Qureshi ◽  
Joanne Xiu ◽  
Maryam Sarraf Yazdy ◽  
Anthony Frank Shields ◽  
Philip Agop Philip ◽  
...  
Keyword(s):  
Age Of Onset ◽  
Late Onset ◽  
Young Patients ◽  
Molecular Profile ◽  
Missense Mutations ◽  
Environmental Carcinogens ◽  
Nras Mutation ◽  
Chi Square ◽  
Primary Tumors ◽  
Egfr Expression

46 Background: Gastric and esophageal adenocarcinomas (GA and EA) in young patients (pts) are more likely driven by genetic factors than environmental carcinogens. Tumor molecular variations defining individual differences in age of onset have not been well elucidated. Methods: Protein expression (IHC), gene amplification (ISH), and next generation sequencing (NGS) were tested on GA and EA tumors. Tumor mutational load (TML) was calculated using only somatic nonsynonymous missense mutations sequenced with a 592-gene panel. Chi-square and t-tests were used for comparative analyses. Results: In total, 1670 tumors were examined; older (age >60) vs. younger (<45)comparisons were made in 599 GA and 491 EA (Table). In GA, significantly higher TOPO2A and TOPO1 expression was seen in older vs. younger pts, while higher mutation rates of FGFR2, IDH1, and NRAS were seen in younger pts. In EA, EGFR expression was higher in the older pts, while ATM and BRCA1 mutations were higher in the younger pts. When only primary tumors were studied, younger GA had a higher NRAS mutation rate (4.5% vs. 0, p=0.02) than older GA, and younger EA had higher cMET amplification (10% vs. 0, p=0.002) and ATM mutations (25% vs. 0, p=0.01) than older EA. In metastatic EA, higher BRCA1mutations (1/2 [50%] vs. 0/12 [0%], p=0.01) and lower EGFR overexpression (81% vs. 29%, p = 0.004) were seen in younger vs. older pts. No differences were seen in the PD-1 or PD-L1 expression rates between the two groups. Mean TML was lower in young GA than old GA (6.2 mutation/megabase vs. 10.4, p=0.005) but was not different between young EA and old EA (5.3 vs. 6.9, p=0.1). Conclusions: Younger GA/EA has a molecular profile unique from older pts, suggesting molecular aberrations play a different part in early-onset disease. Prevalence of aberrations in the young, such as cMET amplification and FGFR2, IDH1, BRCA1mutations may indicate important therapeutic targets. [Table: see text]

scholarly journals Apnea Threshold in Pediatric Brain Death: A Case with Variable Results Across Serial Examinations

2018 ◽  
Vol 08 (02) ◽  
pp. 108-112
Author(s):  
Tina Sosa ◽  
Zachary Berrens ◽  
Susan Conway ◽  
Erika Stalets
Keyword(s):  
Brain Death ◽  
Pediatric Patients ◽  
The Family ◽  
Apnea Threshold ◽  
Unexpected Findings ◽  
Pediatric Brain ◽  
Current Guidelines ◽  
Apnea Testing ◽  
Observation Period

AbstractConsensus guidelines currently exist for the evaluation of pediatric patients with suspected brain death. The guidelines include the requirement for two consistent examinations separated by an observation period and a threshold of 60 mm Hg for PaCO2 during apnea testing. We present a patient who met all prerequisites to perform brain death examination but had variability in examinations during apnea testing. We discuss our strategy in managing these unexpected findings, including the importance of open and ongoing communication with the family, and the implications for current guidelines for the determination of brain death in pediatric patients.

Incidental Diagnosis of Pseudomyxoma Peritonei After Emergent Splenectomy

2020 ◽  
pp. 000313482095482
Author(s):  
Alexandra C. Ferre ◽  
Matthew Burstein ◽  
Kevin M. El-Hayek
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Pseudomyxoma Peritonei ◽  
Exploratory Laparotomy ◽  
Histological Evaluation ◽  
Splenic Trauma ◽  
Computed Tomography Imaging ◽  
Moderate Amount ◽  
Tomography Imaging ◽  
Unexpected Findings

Pseudomyxoma peritonei (PMP) is a rare disease associated with mucinous ascites. Pseudomyxoma peritonei has a low incidence and is difficult to diagnose. Pseudomyxoma peritonei usually presents with vague abdominal pain after significant progression. Computed tomography imaging is the most common modality for diagnosis; however, diagnosis as a result of surgical intervention in cases of acute abdomen has become increasingly common. We present a unique case of a 66-year-old man who was incidentally diagnosed with PMP after undergoing an emergent splenectomy for presumed blunt trauma. The patient presented to the emergency room with abdominal pain, shortness of breath, and diaphoresis. Computed tomography imaging revealed a splenic hematoma with suspicion of extravasation and a moderate amount of free intraperitoneal fluid consistent with blood. The patient was taken to the operating room emergently for an emergent splenectomy where splenic laceration was noted, as were multiple areas of nodularity in the omentum and cecum. Histologic evaluation of these lesions led to the diagnosis of PMP. After recovery from his initial splenectomy, the patient underwent exploratory laparotomy, cytoreductive surgery, cholecystectomy, removal of appendiceal mucocele, and hyperthermic intraperitoneal chemotherapy without complication. Final pathology was consistent with PMP and primary mucinous appendiceal adenocarcinoma. This case highlights an unusual presentation of PMP for a patient who was undergoing surgery for presumed splenic trauma. Surgeons must maintain a high index of suspicion and should perform histological evaluation when such unexpected findings are encountered.

Staging documentation accuracy and adherence to workup and treatment guidelines: The M. D. Anderson Regional Care Center experience.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 244-244
Author(s):  
Amitabha Sarma ◽  
Sunil M. Patel ◽  
Laurie Sturdevant ◽  
Mee-chung Puscilla Ip ◽  
Carol L. Hundley ◽  
...  
Keyword(s):  
Guideline Adherence ◽  
Treatment Guidelines ◽  
Medical Oncology ◽  
Care Center ◽  
Diagnostic Workup ◽  
Adherence Rate ◽  
Monthly Basis ◽  
Medical Oncologists ◽  
Creative Interventions ◽  
Over Time

244 Background: MD Anderson Cancer (MDACC) disease-specific faculty experts have developed institutional guidelines for diagnostic workup and treatment of common tumor types. The institution has four Regional Care Centers in suburban Houston staffed by a total of 10general medical oncologists. The primary intent of this project was to measure the accuracy of staging documentation and adherence to guidelines. The secondary intent was to improve documentation and guideline adherence by regularly reporting results directly to the involved physicians. Methods: Between July 2009 and April 2012, charts for all new medical oncology visits for patients with breast, non-small cell lung, or colon cancer for whom no previous medical oncology plan had been implemented were reviewed by a team of quality nurses on a weekly basis. Source documents were analyzed for (a) adherence to MDACC diagnostic workup guidelines (n=782); (b) accuracy of both TNM and AJCC staging documentation (n=782); and (c) adherence to MDACC treatment guidelines (n=731). On a monthly basis, a graph with rates over time of guideline adherence and accuracy of staging documentation was provided to each general oncologist. Results: The adherence rate to MDACC diagnostic workup guidelines was 79%. The agreement rate for accurate documentation of both TNM and AJCC stage was 72%. The adherence rate to MDACC treatment guidelines was 94%. Providing monthly reports of individual results to each physician did not lead to an increase in the rates of adherence of accurate staging documentation. Analysis comparing all Regional Care Center medical oncologists (not provided to the involved physicians) showed significant variation in rates for all three categories. Conclusions: Providing MDACC Regional Care Center general medical oncologists with simple graphs over time reflecting guideline adherence and accuracy of documentation did not lead to any improvement on those measures. More creative interventions to improve performance in these realms will need to be explored.

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